Prior Authorization Drugs all Provinces, Except Quebec

Under our group plans, certain drugs must be preauthorized. These drugs are known as "prior authorization drugs."

This allows Industrial Alliance to determine whether or not a drug will be eligible for reimbursement under the group plan, prior to an insured making a claim for the drug.

List of drugs - All Provinces (except Quebec)

Condition		Name of Drugs
Actinic Keratosis		Levulan Metvix
Anemia Therapy		Exjade Revlimid
Anti-Obesity		Xenical If your claim is for this drug, the F54-860A form needs to be completed by the attending physician.
Aspergillosis		Vfend
Arthritis		Enbrel Humira Kineret Orencia Remicade Rituxan Simponi
Asthma		Humira Xolair
Cancer (Various)		Abraxane Alimta Avastin Gleevec Herceptin Iressa Matulane Nexavar Sandostatin Sprycel Sutent Tarceva Tasigna Temodal Tykerb Vectibix Vesanoid Xeloda
Crohn's Disease		Remicade
Enzyme Replacement Therapy		Cerezyme Fabrazyme Replagal Zavesca
Eye Diseases		Lucentis Macugen
Growth Hormones		Somatuline
Miscellaneous		Soliris Tygacil
Multiple Sclerosis		Cimzia Tysabri
Narcolepsy		Xyrem
Osteoporosis		Aclasta Aredia Forteo
Psoriasis		Amevive Enbrel Humira Raptiva Stelara
Pulmonary Hypertension		Flolan Remodulin Revatio Thelin Tracleer Volibris
Selected Muscle or Nerve Disorders		Botox Catena Sativex Xeomin

All strengths and generics of the listed drugs are subject to prior authorization.

The prior authorization list is subject to change and does not guarantee that a drug which is listed is covered under a specific group plan.

If you have any questions about this list of prior authorization drugs or the prior authorization process, please contact our Client Service Department at 1 877 422-6487.